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IN THE COMMON PLEAS COURT OF MONTGOMERY COUNTY, OHIO

JUVENILE DIVISION

IN RE:

________________________________________ JC#_____________________________________

________________________________________ JC# ____________________________________

________________________________________ JC# ____________________________________

Minor Child(ren)

SETS# ___________________________________

______________________________________ JUDGE _________________________________

Name

MAGISTRATE ___________________________

______________________________________

Street Address

______________________________________ City, State, Zip Code Petitioner

vs. / and

______________________________________

Name

______________________________________

Street Address

______________________________________

City, State, Zip Code

Respondent

COMPLAINT FOR PARENTAGE

Instructions: One original per child. Consult with local rules to determine what else may be required with this filing.

This form is used to be legally recognized as the parent of the child, be named as the residential parent, or obtain visitation

with the child(ren). The Parenting Proceeding Affidavit and the Affidavit of Income and Expenses are attached.

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1. I, __________________________________________________ (name), am the Plaintiff and the

(select one) Father Mother __________________________ (other) of the following

child(ren):

Name of Child Date of Birth

____________________________________________ ________________________

____________________________________________ ________________________

____________________________________________ ________________________

2. Defendant, _______________________________________ (name), is the

Father Mother __________________________ (other) of the following child(ren).

3. The child has resided in _____________________________County, Ohio since _____________

(date residence established) as set out in the Parenting Proceeding Affidavit.

4. The father-child relationship has has not (select one) been established. If it has been

established, a copy of the order establishing the father-child relationship or a copy of the child’s

birth certificate is attached.

5. No court has issued an order about this child.

The following Court has issued an order about the child(ren) ___________________________

6. I request that the Court (check all that apply):

Name ________________________________________________ (Father’s name) as the

Father of the child ______________________________________________ (child’s name).

Correct the child’s birth certificate to indicate the child’s father.

Order genetic testing and determine the father of the child.

Change the child’s name to ____________________________________________________.

Order the appropriate amount of child support for the child, allocate the income tax

dependency exemption, and determine who should provide health insurance coverage for the

child.

Other (specify): ______________________________________________________________

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7. The reason for this Complaint is: ___________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

_____________________________________________

Your signature

Telephone number at which the Court may

reach you or at which message may be left for you

OATH

(Do not sign until notary is present.)

I, (print name) , swear or affirm that I have read

this document and, to the best of my knowledge and belief, the facts and information stated in this document are

true, accurate and complete. I understand that if I do not tell the truth, I may be subject to penalties for perjury.

Your Signature

Sworn before me and signed in my presence this day of , .

Notary Public

My Commission Expires: